Benefits Guide 2021-2022 - Leon County Schools

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Benefits Guide 2021-2022 - Leon County Schools
2021-2022
Benefits Guide       Open Enrollment
                 July 19 - August 13, 2021
Benefits Guide 2021-2022 - Leon County Schools
Welcome
                                                                                              Inside
Your benefits are an important part of your
                                                                                              Medical Plans
overall compensation. We are pleased to offer a
comprehensive array of valuable benefits to protect                                           Dental Plans
your health, your family and your way of life. This
                                                                                              Vision
guide answers some of the basic questions you may
have about your benefits. Please read it carefully,                                           Flexible Spending
along with any supplemental materials you receive.                                            Accounts (FSAs)
                                                                                              Life and AD&D
Eligibility                                    Choose Carefully!
To be eligible for participation in LCS        Due to IRS regulations, you cannot
                                                                                              Insurance
benefits you must be:                          change your pre-tax elections until
}}Working at least 18.75 hours per             the next annual Open Enrollment                Disability Insurance
                                               period, unless you have a qualified
   week in a regularly established
   position for employees in the LCTA
                                               life event during the year. Following          Employee Assistance
                                               are examples of the most common
   bargaining unit
                                               qualified life events:                         Programs (EAPs)
}}Working at least 17.5 hours per week
                                               }}Marriage or divorce
   for employees in the Local 1010                                                            Voluntary Benefits
   bargaining unit (International Union        }}Birth or adoption of a child
   of Painters & Allied Trades)
                                               }}Child reaching the maximum                   Cost of Benefits
}}Working at least 20 hours per                   age limit
   week for employees in the LESPA
   bargaining unit
                                               }}Death of a spouse or child                   Contact Information
                                               }}You lose coverage under your
}}Hired as an hourly-as-needed                    spouse’s plan
   teacher teaching at least 18.75
   hours per week in a program that is         }}You gain access to state coverage
   continuing from year to year                   under Medicaid or CHIP
You may also enroll your eligible
                                               Making Changes
family members under certain plans
you choose for yourself. Eligible family       To make changes to your benefit

                                                                                             Enrollment
members include:                               elections, you must contact your
                                               Benefits Office at 850-487-7150
}}Your legally married spouse
                                               within 30 calendar days of a
}}Your children who are your                   qualifying event to make changes
   biological children, stepchildren,          to your coverage. Be prepared to              Copy and paste this link
   adopted children or children for            provide documentation of the event
   whom you have legal custody (age            such as a marriage license, birth
                                                                                             https://
   restrictions may apply). Disabled           certificate or a divorce decree. If           www.cyclonebenefits.com/lcs
   children age 26 or older who meet           changes are not submitted on time,
   certain criteria may continue on            you must wait until the next Open
                                                                                             here, you will find detailed
   your health coverage.                       Enrollment period to make your                information about the plans
When Coverage Begins
                                               election changes.                             available to you and
                                                                                             instructions for enrolling.
}} New Hires: You must complete the
enrollment process within 30 calendar          Required Information—When you enroll,
days of your date of hire. If you enroll on    you will be required to enter a Social
time, coverage is effective on the first day   Security number (SSN) for all covered
of the month following your first              dependents. The Affordable Care Act
paycheck. If you fail to enroll on time,       (ACA), otherwise known as health care
                                               reform, requires the company to report
you will NOT have benefits coverage
                                               this information to the IRS each year to
(except for board paid life).                  show that you and your dependents have
                                               coverage. This information will be securely
}}Open Enrollment:                             submitted to the IRS and will remain
                                               confidential.
  Changes made during Open
  Enrollment are effective October 1,
  2021- September 30, 2022.
Benefits Guide 2021-2022 - Leon County Schools
Medical Plans
We are proud to offer you a choice among four different medical plans that provide comprehensive medical and prescription drug
coverage. The plans also offer many resources and tools to help you maintain a healthy lifestyle. Following is a brief description of each plan.

Capital Health Plan HMO                                                             Florida Blue PPO
With this plan, you select a primary care physician (PCP) from the                  These plans give you the freedom to seek care from the provider
participating network of providers who will coordinate your health                  of your choice. The calendar-year deductible must be met before
care needs, refer you to specialists (if needed) and approve further                certain services are covered.
medical treatment. Services received outside of the HMO’s network
are not covered, except in the case of emergency medical care.

           For complete details on Medical Plans and RX Tiers, please see Summary of Benefits on LCS website

                                        Capital Health Capital Health
                                         Plan HMO        Plan HMO                          Florida Blue                             Florida Blue PPO
                                           Capital     Value Selection                    PPO Plan 03559                            Plan 05172/05173
 Key Medical Benefits                                                                                                               High Deductible Plan
                                        Selection Plan  High Deductible
                                                                   Plan
                                        In-Network Only In-Network Only            In-Network         Out-of-Network1         In-Network         Out-of-Network1
 Deductible (per calendar year)                                                                                                 Indivdual
                                                                                                                                                      Familly
  Individual / Family                                                                                 Combined with In-      $3,000 / NA             $10,000 /NA
   Per Person/Family Agreegate            none / none        $2,500 / $5,000      $500 / $1,500      Network / Combined
                                                                                                                             $10,000/NA          $20,000/$20,000
                                                                                                       with In-Network
 Out-of-Pocket Maximum (per calendar year)

   Individual / Family                                                                                Combined with In-
                                        $2,000 / $4,500     $4,000 / $8,500      $2,500 / $7,500     Network / Combined        $6,500 / N/A            $10,000 / N/A
  Per Person/Family Agreegate                                                                          with In-Network
 Covered Services
 Office Visits (physician/specialist)       $15/$40          $15/$75 copay*      $15 / $30 copay               40%*            DED + 10%               DED + 20%
 Routine Preventive Care                   No charge            No charge           No charge                No charge          No charge              DED + 20%
                                                              Preventive
                                                              screening/
 Outpatient Diagnostic (lab/X-ray)         No charge                                No charge                  40%*            DED + 10%               DED + 20%
                                                            Immunization no
                                                                charge
 Complex Imaging                              $100            $250 copay*           $75 copay                  40%*            DED + 10%               DED + 20%
 Chiropractic                              $40 copay           $75 copay*           $30 copay                  40%*            DED + 10%               DED + 20%
                                                                                                            In-Network
 Ambulance                                 $100 copay         $250 copay*           DED + 10%                                  DED + 10%               DED + 20%
                                                                                                          Deductible + 10%
                                         $300/visit $250/     $500 copay;        $100 copay + 10% $100 Copay
 Emergency Room                                                                                              per visit
                                           observation                                                                         DED + 10%               DED + 20%
                                                            $500 observation*                           + 10%

 Urgent Care Facility                   $25 visit/             $50 copay*           $30 copay             Deductible + $30     DED + 10%               DED + 20%
                                        $15 Amwell                                                            copay

                                                             $500/admission;
 Inpatient Hospital Stay                  $250 copay                              Option 1: $400               40%*            DED + 10%               DED + 20%
                                                            $500 observation*

 RX Out-of-Pocket Maximum (per calendar year)

 Individual / Family                     $4,600 / $8,700     $2,850 / $5,200                        N/A                                        N/A

 Prescription Drugs (Tier 1 / Tier 2 / Tier 3)

 Retail Pharmacy (30-day supply)                                                                                                                       In-Network
                                        $15/$30/$50         $15 / $50 / $100 /    $15 / $30 / $50              50%           DED + $10 copay
                                                                   2
                                                                                                                                                     Deductible + 50%

                                                                                                                                                       In-Network
 Mail Order (90-day supply)             $45/$90/$150        $45 / $150 / $300     $30 / $60 / $100             50%           DED + $25 copay         Deductible + 50%
Coinsurance percentages and copay amounts shown in the above chart represent what the member is responsible for paying.
 *Benefits with an asterisk ( * ) require that the deductible be met before the Plan begins to pay.
1. If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount. 2. Limited 30 day supply on Tier 4
Benefits Guide 2021-2022 - Leon County Schools
Benefits Guide 2021-2022 - Leon County Schools
Dental Plans
We are proud to offer you a choice among three different dental plans.
Florida Combined Life DPPO: These plans offer you the freedom and flexibility to use the dentist of your choice. However,
you will maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the Florida
Combined Life network.
Following is a high-level overview of the coverage available.

                                  Florida Combined Life Blue Choice         Florida Combined Life Blue Choice       Florida Combined Life Blue Choice
  Key Dental Benefits                    Standard Plan DPPO                          High Plan DPPO                          Plus Plan DPPO
                                  In-Network Only Out-of-Network1 In-Network Only Out-of-Network1 In-Network Only Out-of-Network1
 Annual Deductible (per calendar year)
 Individual / Family                 $50 / $150            $50 / $150            $50 / $150            $50 / $150      $50 / $150            $50 / $150
 Benefit Maximum (per calendar year; preventive, basic, and major services combined)
 Per Individual                        $750                   $750                 $1,000                  $1,000        $1,250                  $1,250
 Covered Services
 Preventive Services                   20%                    20%               No charge                   10%        No charge                  10%
 Basic Services                        30%                    30%                  20%                      30%           10%                     30%
 Major Services                        30%                    30%                  50%                      40%          40%                      40%
                                                                                           Child & Adult                         Child & Adult
 Orthodontia                           None                   None
                                                                                  $1,000                   $1,000       $1,000                   $1,000

Coinsurance percentages shown in the above chart represent what the member is responsible for paying.
1. If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.

Vision Plan
We are proud to offer you a vision plan.
The Avesis vision plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your
benefits and reduce your out-of-pocket costs if you choose a provider who participates in the Avesis network.
Following is a high-level overview of the coverage available.

  Key Vision Benefits                                         In-Network                                             Out-of-Network
                                                                                                                     Reimbursement
 Exam (once every 12 months)                                      $10                                                    Up to $35
                                                  $15 (Materials copay applies to frame
 Materials Copay                                                                                                           N/A
                                                    or spectacle lenses, if applicable)
 Lenses (once every 12 months)
 Single Vision                                                                                                          Up to $25
 Bifocal                                             Covered in full after $15 copay                                    Up to $40
 Trifocal                                                                                                               Up to $50
 Frames (once every 12 months)                                 Up to $150                                               Up to $50
 Contact Lenses (once every
                                                               Up to $150                                               Up to $128
 12 months; in lieu of glasses)
Benefits Guide 2021-2022 - Leon County Schools
Flexible Spending Accounts                                                                                           FSA Rules
                                                                                                                     YOU MUST ENROLL EACH
We provide you with an opportunity to participate in two different flexible spending                                 YEAR TO PARTICIPATE.
accounts (FSAs) administered through Murfee Meadows. FSAs allow you to set aside a
portion of your income, before taxes, to pay for qualified health care and/or dependent                              Because FSAs can give you a
care expenses. Because that portion of your income is not taxed, you pay less in federal                             significant tax advantage, they
income, Social Security and Medicare taxes. A worksheet that will help you decide how                                must be administered according
much you may want to contribute, is found on the next page.                                                          to specific IRS rules:

 Health Care FSA                                                                                                     Health Care FSA: Unused funds
                                                                                                                     carry over to the following year.
 For 2021, you may contribute up to $2,750 to cover qualified health care expenses incurred by                       Carryover funds will not count
 you, your spouse and your children up to age 26. Some qualified expenses include:
                                                                                                                     against or offset the amount that
 }}Coinsurance                   }}Prescriptions                  }}Eye exams/eyeglasses                             you can contribute annually.
 }}Copayments                    }}Dental treatment               }}Lasik eye surgery                                Dependent Care FSA: Unused
 }}Deductibles                   }}Orthodontia                                                                       funds will NOT be returned to
For a complete list of eligible expenses, visit www.irs.gov/pub/irs-pdf/p502.pdf.                                    you or carried over to the
Getting Reimbursed                                                                                                   following year.
As you incur healthcare expenses throughout the year, you can access your funds by using your Benefits               You can incur expenses through
Card® for eligible expenses or get reimbursed for your out-of-pocket expenses by submitting a claim                  August 31st each year, and must
form. Claims should be sent to Murfee Meadows via fax, email or regular mail found on LCS website..                  file claims by September 30th.
                                                                                                                     Maximum contribution amount is
 Dependent Care FSA                                                                                                  established by the IRS and your
                                                                                                                     employer each year. See plan
 For 2021, you may contribute up to $5,000 (per family) to cover eligible dependent care                             document for details.
 expenses ($2,500 if you and your spouse file separate tax returns). Some eligible expenses
 include: }}Care of a dependent child under the age of 13 by babysitters, nursery schools, pre-
 school or daycare centers.

}}Care of a household member who is physically or mentally incapable of caring for him/herself
    and qualifies as your federal tax dependent
For a complete list of eligible expenses, visit www.irs.gov/pub/irs-pdf/p503.pdf.
Getting Reimbursed
With a Dependent Care FSA, you can only be reimbursed up to the amount that has been deducted
from your paycheck. You can submit claims for reimbursement to Murfee Meadows. Claim forms
can be found on LCS Benefits website.

Life and AD&D Insurance
Life insurance provides your named beneficiary(ies)                 Supplemental Life/AD&D (Employee-paid)
with a benefit in the event of your death.
                                                                    If you determine you need more than the basic coverage, you may
Accidental Death and Dismemberment (AD&D)                           purchase additional coverage through The Standard Company for
insurance provides specified benefits to you in the                 yourself and your eligible family members.
event of a covered accidental bodily injury that
directly causes dismemberment (i.e., the loss of a                                          Benefit Option                                 Guaranteed Issue*
hand, foot or eye). In the event that your death occurs
                                                                                       $10,000 increments; minimum of $10,000
due to a covered accident, both the life and the                     Employee                                                                     $150,000
                                                                                       up to $250,000
AD&D benefit would be payable.
                                                                                       $5,000 increments; miniumum of $5,000
Basic Life/AD&D (Company-paid)                                       Spouse            and maximum of $125,000 (not to                             $50,000
                                                                                       exceed 50% of employee's life coverage)
This benefit is provided at NO COST to you through
The Standard Company.
                                                                                              Option 1                 Option 2
                                                                     Child(ren)
                  $30,000 Benefits reduce by 35% at age                                        $5,000                  $10,000                     $10,000
 Benefit          70, by 50% at age 75, and terminate
 Amount           when the employee is no longer eligible           *During your initial eligibility period only, you can receive coverage up to the Guaranteed Issue
                  or retirement (whichever occurs first)            amounts without having to provide Evidence of Insurability (EOI, or information about your health).
                                                                    Coverage amounts that require EOI will not be effective unless approved by the insurance carrier.
Leon County Schools
        Flexible Spending Account
        Annual Expense Estimate Worksheet
                                                        Actual Expenses              Estimated Expenses                 Dependent Daycare
                                                        Last Year                    New Year                           Account Annual
MEDICAL
Co-pays / expenses                                                                                                      Expense Estimate
   Prescriptions                                    $                                 $
                                                                                                                        CHILD DAYCARE *
   Physician visits                                 $                                 $
                                                                                                                        Full-time daycare (per week)
   Hospital visit co-pays / expenses                $                                 $                                    Child one            $
   (including Emergency)
                                                                                                                           Child two            $
Laboratory / testing expenses                       $                                 $

                                                    $                                 $                                 Part-time daycare (per week)
Deductible expenses
                                                                                                                           Child one            $
Over-the-counter items (medicines                   $                                 $
require a prescription)                                                                                                    Child two            $

                                                                                                                        1. Estimate the cost per week for
VISION                                                                                                                     each category of care
Eye examination Eyeglasses                          $                                 $
                                                                                                                        2. Calculate the annual cost
                                                    $                                 $                                    (Weekly full-time daycare plus
Contact lenses and solution                                                                                                weekly part-time daycare X
                                                    $                                 $                                    number of weeks per year)
Lasik surgery
                                                                                                                        3. Total amount         $
Other expenses                                      $                                 $
                                                                                                                        *Child must be less than 13 years of age.

                                                                                                                        DISABLED / ELDER
HEARING
                                                                                                                        DAYCARE*
Hearing examination                                 $                                 $
                                                                                                                        Caregiver monthly
                                                                                                                        cost              $
Hearing aid                                         $                                 $
                                                                                                                        Multiply monthly
                                                                                                                        cost times number
DENTAL                                                                                                                  of months
                                                                                                                                          $
                                                    $                                 $                                 estimated
Co-pays / expenses

Dental visits                                       $                                 $                                 * Daycare provided for a dependent of
                                                                                                                        any age who requires assistance with the
Fillings                                            $                                 $                                 basic tasks of daily life due to physical or
                                                                                                                        mental challenges.
Major work                                          $                                 $
(root canals, crowns, dentures, etc.)

Orthodontia (braces)                                $                                 $

Deductible expenses                                 $                                 $

Other expenses                                      $                                 $

Total annual amounts                                $              0.00               $              0.00           125info@murfeemeadows.com
This is not, nor is it intended to be, legal or tax advice. Example expenses may not be reimbursable under your
                                                                                                                            800.600.0947
specific plan or restrictions may apply. Federal regulations may change plan features without notice at any time. All
rights reserved. MMI 2019.
Disability Insurance                                                         Employee Assistance
Disability insurance provides benefits that replace part of your
                                                                             Program (EAP)
lost income when you become unable to work due to a covered
injury or illness.
                                                                             Life is full of challenges, and sometimes balancing it is difficult. We
                                                                             are proud to provide a confidential program dedicated to supporting
 Voluntary Short-Term Disability                                             the emotional health and well-being of our employees and their
 Provided at an affordable group rate through The Standard Company.          families. The employee assistance program (EAP) is provided at NO
                                                                             COST to you through Tallahassee Memorial Hospital. You can call
 Benefit Percentage                                60%                       850-431-5190.
 Weekly Benefit Maximum                           $2,000
                                                                             The EAP can help with the following issues, among others:
                                    Option 1                  Option 2       }}Mental health
 When Benefits Begin              After 7th day             After 14th day   }}Relationships or marital conflicts
                                  of disability              of disability
                                                                             }}Child and eldercare
 Maximum Benefit Duration                         90 Days                    }}Substance abuse
 Voluntary Long-Term Disability                                              }}Grief and loss
                                                                             }}Legal or financial issues
 Provided at an affordable group rate through The Standard Company.
                                                                             EAP Benefits
 Benefit Percentage                                60%
                                                                             }}Assistance for you and your household members
 Monthly Benefit Maximum                          $6,000                     }}Up to five (5) in-person sessions with a counselor per issue,
 When Benefits Begin                  After 90th day of disability               per year, per individual
                                                                             }}Unlimited toll-free phone access and online resources
 Maximum Benefit Duration           Social Security Retirement age
Voluntary Benefits
Our benefit plans are here to help you and your family live                                                  We also offer the following additional voluntary benefits:
well—and stay well. But did you know that you can strengthen
your coverage even further? It’s true! Our voluntary benefits                                                Life Benefit Term offered by CHUBB
through The Standard Company are designed to complement
your health care coverage and allow you to customize our                                                     Term Life Insurance provides you and your family with additional
benefits to you and your family’s needs. The best part? Benefits                                             financial protection and peace of mind in the event of a death.
from these plans are paid directly to you! Coverage is also                                                  Plan features include:
available for your spouse and dependents.                                                                    }}Guaranteed acceptance for Life Insurance & Long Term
You can enroll in these plans during Open Enrollment—they’re                                                    Care Insurance
completely voluntary, which means you are responsible for                                                    }}Life Insurance premiums guaranteed for life
paying for coverage at affordable group rates.
                                                                                                             }}Long Term Care coverage worth 3x your death benefit
Accident Insurance                                                                                              amount That’s up to 75 months of care for nursing home,
Accident insurance can soften the financial impact of an                                                        assisted living and home care!
accidental injury by paying a benefit to you to help cover                                                   }}Plan is portable with locked in rates
the unexpected out-of-pocket costs related to treating your
injuries. If you have an accident and seek medical treatment,
                                                                                                             }}Guaranteed future increase option
the policy pays a benefit following treatment for a wide                                                     You choose the coverage level that meets your family’s financial
range of accidents – from minor to catastrophic. If an accident                                              needs. You pay 100% of the premiums through the convenience
causes multiple injuries, we pay a benefit for each one. Follow-                                             of payroll deduction.
up visits,chiropractic care and diagnostic tests are included, as
are more than 100 other benefits. Depending on your needs, you
have two different Accident plans to choose from – Enhanced
and Premier. A complete list of benefits covered under each plan                                             LifeLock
will be provided.                                                                                            You have the option to enroll for identity theft protection. This
                                                                                                             benefit may save you time and money – and restore your name
Critical Illness (includes Cancer Coverage)
                                                                                                             and credit for you if your identity is stolen. Trained experts
Did you know that the average total out-of-pocket cost related                                               provide you with fraud alert notifications, perform proactive
to treating a critical illness is over $7,0001? With critical                                                database searches, and continuously monitor your credit.
illness insurance, you’ll receive a lump-sum benefit if you are
diagnosed with a covered condition that you can use however
you would like, including to help pay for: treatment (e.g.
experimental), prescriptions, travel, increased living expenses
and more. Under this plan, you, your spouse, and children are
covered – your children are covered at no additional cost.
Depending on your needs, you have two different Critical Illness
plans to choose from, Enhanced and Premier.
Hospital Indemnity Insurance
The average cost of a hospital stay is $10,0002—and the
average length of a stay is 4.8 days3. Hospital indemnity
insurance can help reduce costs by paying you or a covered
dependent a benefit to help cover your deductible, coinsurance
and other out-of-pocket costs due to a covered sickness or
injury related hospitalization. Coverage is designed to pay you
benefits for Hospital Admission, Daily Hospital Confinement,
Critical Care Unit Admission, and Critical Care Unit Daily
Confinement. Coverage is available for you, your spouse, and
children and depending on your needs, there are two plans to
choose from, Plan 1 and Plan 2.

1.   MetLife Accident and Critical Illness Impact Study, October 2013

2. Costs for Hospital Stays in the United States, 2011. HCUP Statistical Brief #168. December 2013. Agency
   forHealthcare Research and Quality, Rockville, MD.

3.   National Hospital Discharge Survey: 2010
PLEASE BE AWARE THIS APP IS FOR INFORMATION ONLY. YOU CANNOT ENROLL WITH IT.
Cost of Benefits (10-month)
October 1, 2021 - September 30, 2022
Your contributions toward the cost of benefits are automatically deducted from your paycheck before taxes. The amount will depend upon the
plan you select and if you choose to cover eligible family members.
Monthly Health Plan Premiums Rates are based on 10 deductions, on a year-to-year basis, with the first deduction beginning September
2021 and benefits effective October 1, 2021. The last deduction will be June 2022 with benefits ending September 30, 2022.

Medical

                                                                      Monthly Employee Contribution
                                              Capital Health Plan                                           Florida Blue
    Coverage Tier
                           Capital Selection Plan                    Value Plan              Blue Options                 Blue Options
                               $15/$30/$50                         High Deductible           03559 Plan                  5172/5173 Plan
 Employee Only                     $161.93                         $ 30.23                    $ 235.02                     $142.11
 Employee + Dependent                 $388.63                      $241.80                   $ 742.66                      $449.08
 Family                              $615.33                       $326.44                   $1,090.47                     $659.40
 Med 2- Family                        $323.86                      $ 60.45                   $ 470.03                      $284.22

Dental                                                                       Vision
                             Monthly Employee Contribution                                               Monthly Employee Contribution
                                    Florida Combined Life                       Coverage Tier                          Avesis
    Coverage Tier                                            Blue                                              Plan #150150FY1
                             Blue             Blue
                                                            Choice
                            Choice           Choice                                                                    $7.84
                                                           Standard          Employee Only
                           Plus Plan        High Plan
                                                             Plan
 Employee Only               $ 48.27          $ 34.25        $18.89          Employee + Dependent                      $15.24
 Employee + Dependent        $ 94.80          $ 67.84        $37.07
                                                                             Family                                    $22.38
 Family                       $182.38         $132.71        $73.29

Accident                                                                     Hospital Indemnity
                             Monthly Employee Contribution                                               Monthly Employee Contribution
    Coverage Tier                          The Standard                         Coverage Tier                        The Standard
                               Enhanced                  Premier                                            Plan 1              Plan 2
 Employee Only                    $14.70                  $22.49             Employee Only                  $13.68                  $23.28
 Employee + Spouse                $23.24                  $35.12             Employee + Spouse              $28.80                  $49.26
 Employee + Children              $27.86                  $42.64             Employee + Children            $26.32                  $45.12
 Family                           $43.60                  $66.58             Family                         $44.10                  $75.90

Critical Illness
                 Monthly Employee Contribution

                           The Standard

                  Visit LCS website/Benefits for rates
Cost of Benefits (Pay type 9 Administrators and Exempt Employees only)
October 1, 2021 - September 30, 2022
Your contributions toward the cost of benefits are automatically deducted from your paycheck before taxes. The amount will depend upon the
plan you select and if you choose to cover eligible family members.
Monthly Health Plan Premiums Rates are based on 12 deductions, on a year-to-year basis, with the first deduction beginning September
2021 and benefits effective October 1, 2021. The last deduction will be June 2022 with benefits ending September 30, 2022

Medical

                                                                    Monthly Employee Contribution
                                             Capital Health Plan                                              Florida Blue
    Coverage Tier
                            Capital Selection Plan          Value Selection Plan              Blue Options                       Blue Options
                                $15/$30/$50                       $15/$50/$100                                                  5172/5173 Plan
                                                                                              03559 Plan
 Employee Only                     $134.94                           $25.19                    $195.85                               $118.42
 Employee + Dependent              $323.86                          $201.50                   $618.89                            $374.23
 Family                            $512.77                          $272.03                    $908.73                           $549.50
 Med 2- Family                     $269.88                           $50.38                    $391.69                           $236.85
Dental                                                                        Vision
                             Monthly Employee Contribution                                                Monthly Employee Contribution
                                   Florida Combined Life                         Coverage Tier                             Avesis
    Coverage Tier                                           Blue                                                   Plan #150150FY1
                             Blue            Blue
                                                           Choice
                            Choice          Choice
                                                          Standard            Employee Only                                 $6.53
                           Plus Plan       High Plan
                                                            Plan
 Employee Only                $40.23         $28.54          $15.74           Employee + Dependent                         $12.70
 Employee + Dependent         $79.00         $56.53         $30.89
                                                                              Family                                       $18.65
 Family                       $151.98        $110.59        $61.08
Identity Theft                                                                Hospital Indemnity
                             Monthly Employee Contribution                                                 Monthly Employee Contribution
    Coverage Tier                           LifeLock                             Coverage Tier                         The Standard
                             Benefit Elite         Ultimate Plus                                             Low Plan                  High Plan
 Employee Only                  $7.98                    $13.91               Employee Only                     $11.40                   $19.40
 Family                          $15.98                  $27.83               Employee + Spouse                $24.00                    $41.05
Accident                                                                      Employee + Children              $21.93                    $37.60

                             Monthly Employee Contribution                    Family                           $36.75                    $63.25
    Coverage Tier                         The Standard
                              Enhanced                 Premier
                                                                              Critical Illness
 Employee Only                   $12.25                  $18.74                               Employee Monthly Contribution
 Employee + Spouse               $19.37                  $29.27                                        The Standard
 Employee + Children             $23.22                  $35.53
                                                                                              Visit LCS website/Benefits for rates
 Family                          $36.33                  $55.48
Cost of Benefits (Cont’d)
*If both spouses work for Leon County Schools and need family Medical coverage, there is a significant reduction in the
premium. There are requirements to receive this reduction.

}}Both employees must complete the enrollment process.
}}One employee will accept the responsibility of becoming the primary subscriber and will have the deduction for the
   insurance made from his/her check.
}}Both spouses must agree to notify the Benefits Department within 30 days if one or both employees become ineligible for
   the spouse program due to one of the following reasons:
        1) one or both terminate employment.       4) one employee dies.
        2) in the event of a divorce.              5) one is on a leave of absence.
        3) one or both retire.

        Documentation for all married couples will be required. Documentation for all children being added will also be required.

Supplemental Life/AD&D
Deductions for supplemental Life/AD&D are taken from your paycheck after taxes.
Rates are available during enrollment.

Notes
Nondiscrimination Notification and Contact Information
        “No person shall on the basis of sex (including transgender, gender nonconforming
and gender identity), marital status, sexual orientation, race, religion, ethnicity, national origin,
age, color, pregnancy, disability or genetic information be denied employment, receipt of
services, access to or participation in school activities or programs if qualified to receive such
services, or otherwise be discriminated against or placed in a hostile environment in any
educational program or activity including those receiving federal financial assistance, except as
provided by law.” No person shall deny equal access or a fair opportunity to meet to, or
discriminate against, any group officially affiliated with the Boy Scouts of America, or any other
youth group listed in Title 36 of the United States Code as a patriotic society. An employee,
student, parent or applicant alleging discrimination with respect to employment, or any
educational program or activity may contact:

                            Dr. Kathleen L. Rodgers, Assistant Superintendent
                                    Equity Coordinator (Students) and
                                       Title IX Compliance Officer
                                      Leon County School District
                                       2757 West Pensacola Street
                                        Tallahassee, Florida 32304
                                              (850) 487-7306
                                        rodgersk@leonschools.net

                               Deana McAllister, Assistant Superintendent
                                         Labor and Relations
                                   Equity Coordinator (Employees)
                                           (850) 487-7193
                                     mcallisterd@leonschools.net

          A student or parent alleging discrimination as it relates to Section 504 of

                               the Rehabilitation Act may contact:

                                       Karin Gerold, 504 Specialist
                                             (850) 487-7160
                                        geroldk@leonschools.net
Contact Information
           Coverage                                                                Carrier                                          Phone #                           Website/Email
                                                                 Capital Health Plan Member Services                              850-383-3311                    Memberservices@chp.org
           Medical                                                                                                                                           https://www.floridablue.com/members/group/
                                                                                 Florida Blue                                    877-352-2583
                                                                                                                                                             home
                                                                Teledoc-Florida Blue Option members                     800-Teladoc (800-835-2362)                    www.teladoc.com
           Telehealth
                                                                          Amwell-CHP members                                     855-818-3627                  www.capitalhealth.com/amwell
                                                                                                                                                             https://www.floridabluedental.com/
           Dental                                                          Florida Combined Life                                 1-888-223-4892              members/my-account/
           Vision                                                    Avesis Vision Customer Service                              800-828-9341                         www.avesis.com
           Flexible Spending Accounts (FSAs)                                  Murfee Meadows                                     800-600-0947                    www.murfeemeadows.com

           Life/AD&D                                                     The Standard Company                                    888-937-4783                        www.standard.com

           Disability                                                    The Standard Company                                    888-937-4783                        www.standard.com

           Employee Assistance Program                                                                                                                        https://www.tmh.org/services/eap
                                                                        Tallahassee Memorial EAP                                  850-431-5190
           (EAP)

           Voluntary Benefits                                            The Standard Company                                    888-937-4783                        www.standard.com

          Identity Theft                                                         LifeLock                                        800-607-9174                https://memberportal.lifelock.com/support

              Benefits Website
            Our benefits website https://
            www.leonschools.net/Page/31129
            can be accessed anytime you want
            additional information on our benefits
            programs.
              Our enrollment website https://www.
              cyclonebenefits.com/lcs can be
              accessed anytime you want additional
              information regarding enrollment.

             Questions?
              If you have additional questions, you
              may also contact:
               LCS Enrollment Call Center
               888-783-9653
               fla.tal.lcdshelp@hubinternational.com
              Benefits Department
              850-487-7150

DISCLAIMER: The material in this benefits brochure is for informational purposes only and is neither an offer of coverage or medical or legal advice. It
contains only a partial description of plan or program benefits and does not constitute a contract. Please refer to the Summary Plan Description (SPD) for
complete plan details. In case of a conflict between your plan documents and this information, the plan documents will always govern. Annual Notices:
ERISA and various other state and federal laws require that employers provide disclosure and annual notices to their plan participants. The company will
distribute all required notices annually.
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